Total Pancreatectomy and Islet Autotransplantation in Children for Chronic Pancreatitis: Indication, Surgical Techniques, Postoperative Management, and Long-Term Outcomes

• Published in: Annals of surgery Vol. 260; no. 1; pp. 56 - 64
• Main Authors: Chinnakotla, Srinath, Bellin, Melena D, Schwarzenberg, Sarah J, Radosevich, David M, Cook, Marie, Dunn, Ty B, Beilman, Gregory J, Freeman, Martin L, Balamurugan, A N, Wilhelm, Josh, Bland, Barbara, Jimenez-Vega, Jose M, Hering, Bernhard J, Vickers, Selwyn M, Pruett, Timothy L, Sutherland, David E R
• Format: Journal Article
• Language: English
• Published: United States by Lippincott Williams & Wilkins 01-07-2014
• Subjects: Abdominal Pain - diagnosis; Abdominal Pain - etiology; Abdominal Pain - therapy; Adolescent; Child; Cholangiopancreatography, Endoscopic Retrograde; Endosonography; Female; Follow-Up Studies; Humans; Incidence; Islets of Langerhans Transplantation - methods; Male; Minnesota - epidemiology; Pain Measurement; Pancreatectomy - methods; Pancreatitis, Chronic - complications; Pancreatitis, Chronic - diagnosis; Pancreatitis, Chronic - surgery; Postoperative Care - methods; Postoperative Complications - epidemiology; Postoperative Complications - prevention & control; Quality of Life; Retrospective Studies; Severity of Illness Index; Time Factors; Tomography, X-Ray Computed; Transplantation, Autologous; Treatment Outcome; Minnesota
• ISSN: 0003-4932; 1528-1140
• DOI: 10.1097/SLA.0000000000000569

OBJECTIVE:Describe the surgical technique, complications, and long-term outcomes of total pancreatectomy and islet autotransplantation (TP-IAT) in a large series of pediatric patients.
BACKGROUND:Surgical management of childhood pancreatitis is not clear; partial resection or drainage procedures often provide transient pain relief, but long-term recurrence is common due to the diffuse involvement of the pancreas. Total pancreatectomy (TP) removes the source of the pain, whereas islet autotransplantation (IAT) potentially can prevent or minimize TP-related diabetes.
METHODS:Retrospective review of 75 children undergoing TP-IAT for chronic pancreatitis who had failed medical, endoscopic, or surgical treatment between 1989 and 2012.
RESULTS:Pancreatitis pain and the severity of pain statistically improved in 90% of patients after TP-IAT (P < 0.001). The relief from narcotics was sustained. Of the 75 patients undergoing TP-IAT, 31 (41.3%) achieved insulin independence. Younger age (P = 0.032), lack of prior Puestow procedure (P = 0.018), lower body surface area (P = 0.048), higher islet equivalents (IEQ) per kilogram body weight (P = 0.001), and total IEQ (100,000) (P = 0.004) were associated with insulin independence. By multivariate analysis, 3 factors were associated with insulin independence after TP-IAT(1) male sex, (2) lower body surface area, and (3) higher total IEQ per kilogram body weight. Total IEQ (100,000) was the single factor most strongly associated with insulin independence (odds ratio = 2.62; P < 0.001).
CONCLUSIONS:Total pancreatectomy and islet autotransplantation provides sustained pain relief and improved quality of life. The β-cell function is dependent on islet yield. Total pancreatectomy and islet autotransplantation is an effective therapy for children with painful pancreatitis that failed medical and/or endoscopic management.